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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801652
Report Date: 09/09/2022
Date Signed: 09/09/2022 11:02:15 AM

Document Has Been Signed on 09/09/2022 11:02 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SOLVANG FRIENDSHIP HOUSE-ADPFACILITY NUMBER:
425801652
ADMINISTRATOR:TAMMY WESTWOODFACILITY TYPE:
775
ADDRESS:880 FRIENDSHIP LANETELEPHONE:
(805) 688-8748
CITY:SOLVANGSTATE: CAZIP CODE:
93463
CAPACITY: 15CENSUS: 13DATE:
09/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Tammy Westwood, Executive Director/Administrator, and Aisa Coronel, Life Enrichment Day Program Coord.TIME COMPLETED:
11:25 AM
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On 9/09/22 at 10:19 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced on-site annual infection control visit to the facility listed above. LPA met with Tammy Westwood, Executive Director/Administrator, and Aisa Coronel, Life Enrichment Day Program Coordinator, and explained the purpose of the visit.

LPA toured the facility with the administrator and life enrichment coordinator and observed the following: Upon entry to the facility, LPA was screened and signed-in. Staff are wearing masks. The facility has soap and paper towels in client bathrooms. The fire extinguisher is located to the right of the south exit door. The extinguisher is fully charged and was inspected on 9/05/22. The facility has infection control signage at the front door and signage throughout the program area on handwashing, cough etiquette and use of masks.

At 10:31 am LPA conducted the Infection Control mitigation module with the administrator and life enrichment coordinator. No deficiencies cited.

Exit interview conducted and the report emailed to the administrator and life enrichment coordinator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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